Patient-reported health-related quality of life as complex patient outcomes in stroke survivors

患者报告的与健康相关的生活质量是中风幸存者的复杂患者结果

• 批准号: 10559994
• 负责人: Julianne Xinting Murphy
• 金额: $ 4.19万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2023-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10559994
• 关键词: Patient; reported; health; related; quality

Project Summary In the U.S., approximately 700,000 Americans experience a stroke each year, resulting in substantial morbidity and mortality. Stroke affects multiple domains of health-related quality of life (HRQoL), and in an aging U.S., we are likely to see an increase in stroke because the risk of stroke increases with age. The standard measure for patient outcomes after stroke is the modified Rankin Scale (mRS) which heavily focuses on patient mobility and is less discriminating for other domains of HRQoL (e.g., cognitive function, depression, fatigue, anxiety). However, patients often have complex patient outcomes with varying degrees of abnormal HRQoL across multiple domains, and not much is known about how these HRQoL scores cluster together. Reductions in HRQoL other than mobility remain difficult to predict, limiting patient outcomes assessment and management. To address this need, we will identify complex patient outcomes that incorporate multiple HRQoL domains and predict individual complex patient outcomes at 3-month follow-up from variables collected during the index hospitalization. Identifying complex patient outcomes after stroke may help clinicians and researchers quickly comprehend the multi-dimensional patterns of outcomes and better inform patients and families. The study's objectives are to assess differentially identified HRQoL domains as the driver of complex patient outcomes and to predict complex patient outcomes for stroke survivors. Follow-up care after stroke could be more efficient if it were possible to anticipate and proactively address the complex needs of stroke patients based on their index hospital stay. To meet the objectives, Aim 1 will determine the HRQoL domains that are not well described by the standard mRS for patient outcomes. Aim 2 will identify complex patient outcomes across multiple domains of HRQoL in patients with the 3 major types of stroke (i.e., AIS, ICH, SAH). Aim 3 will predict complex patient outcomes at follow-up from patient data accumulated during their index hospitalization. We will use data from 3 sources: 1) the Northwestern University Brain Attack Registry (NUBAR), a prospectively collected registry of electronic health records with detailed information on patient outcomes after stroke, 2) the Northwestern Medicine Enterprise Data Warehouse (NMEDW), a robust data infrastructure spanning 11-hospitals that collects and stores electronic health records for more than 6 million unique patients, and 3) the Antihypertensive Treatment of Acute Cerebral Hemorrhage-II (ATACH-II), a clinical trial dataset of 1,000 patients with ICH. Findings from this study will: 1) identify the HRQoL domains obscured by current global outcome measures, 2) contribute information for defining complex patient outcomes after stroke that account for multiple HRQoL domains, and 3) suggest whether individual complex patient outcomes at 3-month follow- up can be predicted during a patient's initial hospitalization. The study aligns with AHRQ's mission and strategy by addressing 2 priority areas: 1) patient-reported outcomes, and 2) harnessing data and technology to provide a 360-degree view of the patient that coordinates health and behavioral health in a person-centered manner.

项目摘要 在美国，每年大约有70万美国人经历中风，导致相当大的发病率 and mortality.中风影响健康相关生活质量（HRQoL）的多个领域，在老龄化的美国， 我们很可能会看到中风的增加，因为中风的风险随着年龄的增长而增加。标准措施 卒中后患者结局的标准是改良的兰金量表（mRS），该量表主要关注患者的活动性 并且对于HRQoL的其它领域的区分性较低（例如，认知功能、抑郁、疲劳、焦虑）。 然而，患者通常具有复杂的患者结局，不同程度的HRQoL异常， 多个领域，并没有太多的人知道这些HRQoL分数聚类在一起。减少 HRQoL（活动性除外）仍然难以预测，限制了患者结局评估和管理。 为了满足这一需求，我们将确定包含多个HRQoL领域的复杂患者结局， 根据索引期间收集的变量预测3个月随访时个体复杂患者的结局 住院识别中风后复杂的患者结局可能有助于临床医生和研究人员快速 了解结果的多维模式，并更好地告知患者和家属。该研究的 目的是评估作为复杂患者结局驱动因素的不同HRQoL领域， 来预测中风幸存者的复杂预后。中风后的随访护理可能会更有效， 能够根据他们的指数预测并主动解决中风患者的复杂需求 住院。为了实现目标，目标1将确定未被很好描述的HRQoL领域， 患者结局的标准mRS。目标2将确定多个领域的复杂患者结局 3种主要类型卒中患者的HRQoL（即，AIS、ICH、SAH）。目标3将预测复杂患者 随访时的结果来自患者在首次住院期间积累的数据。我们将使用来自3 资料来源：1）西北大学脑攻击登记处（NUBAR），一个前瞻性收集的登记处， 电子健康记录与中风后患者结局的详细信息，2）西北 医药企业数据仓库（NMEDW）是一个强大的数据基础设施，涵盖11家医院， 收集和存储超过600万独特患者的电子健康记录，以及3） 急性脑出血的抗高血压治疗-II（ATACH-II），1000例临床试验数据集 ICH患者。这项研究的结果将：1）确定HRQoL领域被当前的全球 结果测量，2）为定义卒中后复杂患者结果提供信息， 对于多个HRQoL领域，和3）表明3个月时个体复杂患者结局是否遵循- 可以在患者最初住院期间预测UP。这项研究符合AHRQ的使命和战略 通过解决2个优先领域：1）患者报告的结局，2）利用数据和技术提供 以人为中心的方式协调健康和行为健康的患者360度视图。